Delirio en ancianos / Delirium in older people

Octubre 23, 2015. No. 2123Octubre, mes de lucha contra cáncer de mama.

Intervenciones para la prevención del delirio en las personas mayores en la atención institucional a largo plazo. Interventions for preventing delirium in older people in institutional long-term care. Clegg A, Siddiqi N, Heaven A, Young J, Holt R. Cochrane Database Syst Rev. 2014 Jan 31;1:CD009537. doi: 10.1002/14651858.CD009537.pub2. Abstract BACKGROUND: Delirium is a common and distressing complication of a range of stressor events including infection, new medications and environment change that is often experienced by older people with frailty and dementia. Older people living in institutional long-term care (LTC)are at high risk of delirium, which increases the risk of admission to hospital, development of or worsening of dementia, and mortality.Delirium is also associated with substantial healthcare costs. Although it is possible to prevent delirium in the hospital setting by providing multicomponent delirium prevention interventions it is currently unclear whether interventions to prevent delirium in LTCare effective. OBJECTIVES: To assess the effectiveness of interventions for preventing delirium in older people in long term care. SEARCH METHODS: We searched ALOIS (www.medicine.ox.ac.uk/alois) - the Cochrane Dementia and Cognitive Improvement Group's Specialised Register- on 23 April 2013. The search was as sensitive as possible to identify all studies on ALOIS relating to delirium. We ran additional separate searches in major healthcare databases, trial registers, the Cochrane Central Register of Controlled Trials (CENTRAL) and grey literature sources, to ensure that the search was as comprehensive as possible. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-randomised controlled trials (cluster-RCTs) of single- and multi componentn on-pharmacological and pharmacological interventions for preventing delirium in older people (aged 65 years and over) in permanent LTC residence. DATA COLLECTION AND ANALYSIS: Two independent review authors examined the titles and abstracts of citations identified by the search for eligibility and extracted data, with any disagreements settled by consensus. Primary outcomes were prevalence, incidence and severity of delirium. Secondary outcomes included new diagnosis of dementia, activities of daily living, quality of life and adverse outcomes. We used risk ratios (RRs)as measures of treatment effect for dichotomous outcomes and hazard ratios (HR) for time to event data.Main results We included two trials that recruited 3636 participants.Both were complex single-component non-pharmacological delirium prevention interventions. Risk of bias for many items was unclear due to inadequate reporting. Notably, there was no evidence of blinding of trial participants or assessors in either trial. One small cluster-RCT (n = 98) of a hydration-based intervention reported no reduction in delirium incidence in the intervention group compared to control (RR 0.85, 95% confidence interval (CI) 0.18 to 4.00, analysis not adjusted for clustering, very low quality evidence). Results were imprecise and there were serious limitations evident in trial design.One large cluster-RCT (n = 3538) of a computerised system to identify medications that may contribute to delirium risk and trigger a pharmacist-led medication review reported a large reduction in delirium incidence (12-month HR 0.42, CI 0.34 to 0.51, moderat equality evidence) but no clear evidence of reduction in hospital admissions (HR 0.89, CI 0.72 to 1.10, moderate quality evidence), in mortality (HR 0.88, CI 0.66 to 1.17, moderate quality evidence) or in falls risk (HR 1.03, CI 0.92 to 1.15, moderate quality evidence).Authors' conclusions Our review identified very limited evidence on interventions for preventing deliriumin older people in LTC. Introduction of a software based intervention to identify medications that could contribute to delirium risk so that a pharmacist-led medication review and monitoring plan can be initiated may reduce incidence of delirium for older people in institutional LTC. This is based on one large RCT in the United States and may not be practical in other countries which do not have comparable information technology services available in care homes. Our review identified only one ongoing pilot trial of a multicomponent delirium prevention intervention and no trials of pharmacological agents. Future trials of computerised medication management systems and multicomponent non-pharmacological and pharmacological delirium prevention interventions for older people in LTC are needed to help inform the provision of evidence based care for this vulnerable group. PDF Efectos de dos métodos de anestesia-analgesia sobre la incidencia de delirio postoperatorio en los ancianos operados de cirugía mayor torácica y abdominal Effects of two different anesthesia-analgesia methods on incidence of postoperative delirium in elderly patients undergoing major thoracic and abdominal surgery: study rationale and protocol for a multicenter randomized controlled trial. Li YW, Li HJ, Li HJ1, Feng Y, Yu Y, Guo XY, Li Y, Zhao BJ, Hu XY, Zuo MZ, Zhang HY, Wang MR, Ji P,Yan XY, Wu YF, Wang DX. BMC Anesthesiol. 2015 Oct 13;15(1):144. doi: 10.1186/s12871-015-0118-5. Abstract BACKGROUND: Delirium is a common complication in elderly patients after surgery and associated with increased morbidity and mortality. Studies suggest that deep anesthesia and intense pain are important precipitating factors of postoperative delirium. Neuraxial block is frequently used in combination with general anesthesia for patients undergoing major thoracic and abdominal surgery. Compared with general anesthesia alone and postoperative intravenous analgesia, combined epidural-general anesthesia and postoperative epidural analgesia decreases the requirement of general anesthetics during surgery and provided better pain relief after surgery. However, whether combined epidural-general anesthesia plus epidural analgesia is superior to general anesthesia plus intravenous analgesia in decreasing the incidence of postoperative delirium remains unknown. METHODS/DESIGN: This is a multicenter, open-label, randomized, parallel-controlled clinical trial. One thousand eight hundred elderly patients (age range 60-90 years) who are scheduled to undergo major thoracic or abdominal surgery are randomized to receive either general anesthesia plus postoperative intravenous analgesia or combined epidural-general anesthesia plus postoperative epidural analgesia. The primary outcome is the 7-day incidence of postoperative delirium. Secondary outcomes include the duration of postoperative delirium, the intensity of pain during the first three days after surgery, the 30-day incidences of postoperative non-delirium complications, the length of stay in hospital after surgery and 30-day all-cause mortality. DISCUSSION: Results of the present study will provide information to guide clinical practice in choosing appropriate anesthesia-analgesia method for elderly patients undergoing major thoracic and abdominal surgery. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Dexmedetomidina en ancianos/Dexmedetomidine in the elderly

Octubre 24, 2015. No. 2124Octubre, mes de lucha contra cáncer de mama.

Efectos de dexmedetomidina sobre despertar suave de la anestesia en ancianos de cirugía ortopédica Effects of dexmedetomidine on smooth emergence from anaesthesia in elderly patients undergoing orthopaedic surgery. Kim DJ, Kim SH, So KY, Jung KT. BMC Anesthesiol. 2015 Oct 7;15(1):139. doi: 10.1186/s12871-015-0127-4.  CONCLUSIONS: Dexmedetomidine may be an effective intraoperative adjuvant for a reducing emergence agitation and smooth emergence from anaesthesia after orthopaedic surgery in elderly patients. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Medwave. Edición completa del mes de octubre

Medwave <cursos@medwave.cl>



oct 31 a las 3:31 A.M.

Hemos completado la edición correspondiente al mes de octubre de 2015. Los artículos incluidos son los siguientes:


CARTA A LA EDITORA

Ensayos clínicos en países latinoamericanos
José Kelvin Gálvez-Olortegui, Tomas Vladimir Gálvez-Olortegui, Yudy Cley Cóndor-Rojas (Perú)

Medwave 2015 Oct;15(9):e6294
http://dx.doi.org/10.5867/medwave.2015.09.6294


REPORTES DE CASO

Hernia pulmonar espontánea: a propósito de un caso clínico
Felipe Petour Gazitúa, Javiera Pérez Velásquez, Felipe Quintanilla Guidobono, Jeanne Marie Chehade (Chile)

Medwave 2015 Oct;15(9):e6284
http://dx.doi.org/10.5867/medwave.2015.09.6284


Bloqueo de rama alternante taquicardia-dependiente en cardiopatía isquémica con disfunción sistólica: descripción de caso y revisión de implicancias pronósticas
Federico Ferrando, Alejandro Vidal, Roberto Ricca-Mallada, Romina Nogara, Pablo Marichal, Fabián Martínez (Uruguay)

Medwave 2015 Oct;15(9):e6285
http://dx.doi.org/10.5867/medwave.2015.09.6285


Púrpura de Henoch Schonlein asociada a picadura de abeja: reporte de caso
José Gálvez-Olortegui, Mayita Álvarez-Vargas, Juan Durand-Vergara, Marisol Díaz-Lozano, Tomas Gálvez-Olortegui, Indira Armas-Ramírez, Julio Hilario-Vargas (Perú)

Medwave 2015 Oct;15(9):e6297
http://dx.doi.org/10.5867/medwave.2015.09.6297


ANÁLISIS

El desafío de los sistemas de salud en el siglo XXI: ¿cómo incorporar el enfoque de los determinantes sociales de la salud?
Cristóbal Cuadrado (Chile)

Medwave 2015 Oct;15(9):e6289
http://dx.doi.org/10.5867/medwave.2015.09.6289


REVISIÓN CLÍNICA

El uso de corticoides antenatales en cesáreas electivas de término, ¿reduce la morbilidad respiratoria?
Felipe Petour Gazitúa, Javiera Pérez Velásquez (Chile)

Medwave 2015 Oct;15(9):e6280
http://dx.doi.org/10.5867/medwave.2015.09.6280


ARTÍCULO DE REVISIÓN

Periodontitis como determinante del inicio y progresión de la enfermedad de Huntington: revisión de la literatura
María Lourdes Rodríguez Coyago, Victoria Emilia Sánchez Temiño (Argentina)

Medwave 2015 Oct;15(9):e6293
http://dx.doi.org/10.5867/medwave.2015.09.6293


ANÁLISIS CRÍTICO

Revisión de las guías actuales de hipertensión arterial
Mayita Lizbeth Álvarez-Vargas, José Kelvin Galvez-Olortegui, Tomas Vladimir Galvez-Olortegui, José Manuel Sosa-Rosado, Luis Arturo Camacho-Saavedra (Perú)

Medwave 2015 Oct;15(9):e6290
http://dx.doi.org/10.5867/medwave.2015.09.6290



Para mayor información sobre envío de manuscritos, revisión y como publicar en Medwave escribir directamente a Rodrigo Núñez publishing@medwave.cl

Para mayor información sobre cursos y capacitación escribir a mguillen@medwave.cl


PORTADA MEDWAVE
http://www.medwave.cl

PORTADA eCAMPUS
http://www.medwave.cl/link.cgi/eCampus/Capacitacion

Marfan, embarazo y aneurisma aórtico / Marfan, pregnancy and aortic aneurism

Octubre 31, 2015. No. 2131Octubre, mes de lucha contra cáncer de mama.

Ver galeria View gallery El síndrome de Marfan es un trastorno multisistémico del tejido conectivo, con la participaciónprincipal de los sistemas cardiovascular, ocular y esquelético. El diagnóstico clínico del síndrome de Marfan se ha basado en los criterios de Ghent desde 1996. Entre sus muchas diferentesmanifestaciones clínicas cursa con afectación cardiovascular que merece una consideración especial, debido a su impacto en el pronóstico. Las mujeres embarazadas con síndrome de Marfancorren un riesgo particularmente alto de embarazo adverso y los eventos cardiovasculares pueden ser mortales.Se presenta un caso de una mujer con sindrome de Marfan y embarazo que falleció en postparto por un aneurisma aórtico toraco-abominal.   Marfan syndrome is a multisystem connective tissue disorder, with primary involvement of the cardiovascular, ocular, and skeletal systems. Clinical diagnosis of Marfan syndrome has been based on the Ghent criteria since 1996. Among its many different clinical manifestations, cardiovascular involvement deserves special consideration, owing to its impact on prognosis. Pregnant women with Marfan syndrome are at a particularly high risk of adverse pregnancy and cardiovascular events. We e-mail you images of a case of a woman with Marfan syndrome and pregnancy who died at the postpartum period due to an aortic thoracic-abdominal aneurysm.   Manifestaciones cardiovasculares deelsíndrome de Marfan y enfermedades relacionadas. Múltiples genes produciendo fenotipos similares Cardiovascular manifestations in Marfan syndrome and related diseases; multiple genes causing similar phenotypes. Cook JR, Carta L, Galatioto J, Ramirez F. Clin Genet. 2015;87(1):11-20. doi: 10.1111/cge.12436. Epub 2014 Jul 10. PDF Perspectivas sobre los criterios revisados de Ghent para diagnóstico de síndrome de Marfan Perspectives on the revised Ghent criteria for the diagnosis of Marfan syndrome. von Kodolitsch Y, De Backer J, Schüler H, Bannas P, Behzadi C, Bernhardt AM, Hillebrand M,Fuisting B, Sheikhzadeh S, Rybczynski M, Kölbel T, Püschel K, Blankenberg S, Robinson PN. Appl Clin Genet. 2015 Jun 16;8:137-55. doi: 10.2147/TACG.S60472. eCollection 2015. PDF Síndrome de Marfan: Una vision del síndrome. Marfan syndrome: An eyesight of syndrome. Kumar A, Agarwal S. Meta Gene. 2014 Jan 14;2:96-105. doi: 10.1016/j.mgene.2013.10.008. eCollection 2014. PDF Tratamiento médico de los aneurismas aórtivos en síndrome de Marfan y otras condiciones hereditarias Medical treatment of aortic aneurysms in Marfan syndrome and other heritable conditions. Attenhofer Jost CH, Greutmann M, Connolly HM, Weber R, Rohrbach M, Oxenius A, Kretschmar O,Luscher TF, Matyas G1. Curr Cardiol Rev. 2014 May;10(2):161-71. Abstract PDF Síndrome de Marfan y embarazo: Evolución materna y neonatal Marfan syndrome and pregnancy: maternal and neonatal outcomes. Curry RA1, Gelson E, Swan L, Dob D, Babu-Narayan SV, Gatzoulis MA, Steer PJ, Johnson MR. BJOG. 2014 Apr;121(5):610-7. doi: 10.1111/1471-0528.12515. Epub 2014 Jan 13. PDF Supervisión de salud para los niños con el síndrome de Marfan. Health supervision for children with Marfan syndrome. Tinkle BT, Saal HM; Committee on genetics. Pediatrics. 2013 Oct;132(4):e1059-72. doi: 10.1542/peds.2013-2063. Epub 2013 Sep 30. PDF  RNM cardiovascular en síndrome de Marfan Cardiovascular magnetic resonance in Marfan syndrome. Dormand H, Mohiaddin RH. J Cardiovasc Magn Reson. 2013 Apr 15;15:33. doi: 10.1186/1532-429X-15-33. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015